CN104540463A

CN104540463A - Implants/procedures related to tibial tuberosity advancement

Info

Publication number: CN104540463A
Application number: CN201380031287.8A
Authority: CN
Inventors: J-N.博尔多; T.J.霍兰
Original assignee: Synthes GmbH
Current assignee: Synthes GmbH
Priority date: 2012-06-14
Filing date: 2013-03-05
Publication date: 2015-04-22
Also published as: BR112014031372A2; IN2014DN10252A; US20130338781A1; US11224515B2; AU2013274872A1; US20160151160A1; CA2876834A1; KR20150032287A; EP2861170A1; JP2015519176A; WO2013187950A1

Abstract

A tibial tuberosity advancement (TTA) system (100) is configured to maintaining a tuberosity (30) in an advanced position relative to a tibial body (23). The TTA system includes an implant (104), a spacer (102), and a spacer fixation member (128).

Description

Implant/the operation relevant to tibial tubercle sacrolisthesis

The cross reference of related application

The rights and interests of the U.S. Provisional Patent Application 61/659,655 of patent application claims submission on June 14th, 2012, its disclosure is incorporated to herein accordingly by reference in full.

Technical field

Present patent application relates generally to for the system of stable deficiency patella, equipment and method, and more specifically, relates to the system for performing the operation of tibial tubercle sacrolisthesis, equipment and method.

Background technology

See Fig. 1, the knee joint 20 of quadruped (such as cat and Canis familiaris L.) is connected tibia 22 and femur 24 with pivoting relationship.Knee joint 20 comprises multiple stable tendon for supporting this joint between anatomy functional period and ligament.Such as, be similar to most of body weight of anterior cruciate ligament (CCL) support animals of the anterior cruciate ligament in human body, and be important for the stability in the large of knee joint 20.CCL is attached to tibia 22 and femur 24, and CCL prevents in general or limits tibia 22 relative to femur 24 Slideslip forward or forward, also limits the internal rotating of tibia 22 relative to femur 24 and the overextension of knee joint 20.Knee joint 20 also comprises meniscus 26, and this meniscus 26 is arranged between tibia 22 and femur 24, and it absorbs and impacts and provide slidingsurface between femur 24 and the tibial plateau 28 of tibia 22.

The tuberosity bone 30 that tibia 22 comprises tibia main body 23 and extends from tibia main body 23.Kneecap tendon 32 is anchored between tuberosity bone 30 and femur 24.As shown in Figure 1, extend through kneecap tendon 32 and perpendicular to kneecap tendon and the line 27 pointing to tibial plateau 28 be angularly biased relative to line 29, the position in the plane that line 29 limits substantially at tibial plateau 28 and between kneecap tendon 32 and tibial plateau 28 is crossing with line 27.Therefore, when CCL impaired (this is common damage in Canis animals), owing to can produce shin stock shearing when weight is applied to the knee joint 20 of damage, therefore patellar ligament 32 can not prevent femur 24 from moving along tibial plateau 28.As a result, the damage of CCL usually can cause affected knee joint maimed, makes meniscus 26 impaired and cause degenerative joint disease due to femur 24 applied force.In addition, animal is often to impaired knee joint 20 over compensation, and this can cause the CCL of other knee joint to break during load-bearing anatomical function.

Also see Fig. 2, tibial tubercle sacrolisthesis art (TTA) is designed for repair the operation of affected knee joint 20 due to the anterior cruciate ligament of damage.Conventional TTA comprises the following steps: perform sacrotomy tibial tubercle bone 30 and tibia main body 23 to be separated, subsequently therefore kneecap tendon 32 is also advanced to position isolated with tibia 22, to limit gap 40 between tibial tubercle bone 30 and tibia main body 23 by tibial tubercle bone 30 towards front side.Such as, during TTA, usually tibial tubercle bone 30 and kneecap tendon 32 are moved forward, make to extend through kneecap tendon 32 and perpendicular to kneecap tendon 32 and the line 27 pointing to tibial plateau 28 be also arranged essentially parallel to line 29 and can overlap with line 29, line 29 is arranged in the plane substantially limited by tibial plateau 28.Therefore, line 27 can be arranged essentially parallel to the plane that limited by tibial plateau 28 or with this planes overlapping.In general, compared with before TTA, after TTA, line 27 is more parallel to line 29 or more overlaps with line 29, and is therefore more parallel to the plane that limited by tibial plateau 28 or more overlaps with this plane.Subsequently tibial tubercle bone 30 is fixed on reach position, neutralizes the shin stock shearing produced when weight is applied to knee joint 20 like this, thus reduce or avoid completely the anatomy function of CCL.

Therefore, continue see Fig. 2, conventional TTA system 34 comprises hone lamella 36 and the distance piece 38 in rack form, this hone lamella 36 is connected to tibia 22 at one end, the tibial tubercle bone 30 of reach is connected at other end place, to provide the tibial tubercle bone 30 of reach and the fixing of tibia main body 23, this distance piece 38 and hone lamella 36 separate and arrange and be connected between the tibial tubercle bone 30 of reach and tibia main body 23, to resist the gap 40 of holding between tibial tubercle bone 30 and tibia main body 23 of trying hard to keep towards afterbody of kneecap tendon 32.

Develop many apparatuses, equipment, system and method and carried out TTA operation in Canis familiaris L..But, still expect the improvement to those apparatuses and implant.

Summary of the invention

The disclosure relates to for reach tuberosity bone being remained on the TTA system moved forward in position relative to tibia main body.The reach position of tuberosity bone relative to tuberosity bone and tibia main body integral time primary importance proximally spaced apart towards front side.In one embodiment, TTA system comprises implant, distance piece and distance piece fixed component substantially.Implant comprises implant main body, and this implant main body limits: be configured in reach position, support the proximal part of reach tuberosity bone, the distal portions being configured to be attached to tibia main body and the middle implant part extended between proximal part and distal portions.Mid portion is by molding, so that relative to distal portions, towards front side, also proximally reach tuberosity bone is remained on the amount in reach position or distance by spaced apart being enough to by near-end.Distance piece be configured and size be set to when distal portions and proximal part be attached to respectively tibia main body 23 and reach tuberosity bone time be engaged in be arranged at reach tuberosity bone and tibia main body 23 between gap in.Distance piece comprises distance piece main body and limits the slit extending through distance piece main body.Distance piece fixed component comprises: be configured to be attached to the first end part of reach tuberosity bone, the second end part being configured to be attached to tibia main body and the intermediate fixed portion extended between first end and the second end.Intermediate fixed portion is configured and size is set to and is received in slit at least in part, distance piece fixed component is attached to distance piece.

The disclosure also relates to TTA reach assembly, and tuberosity bone is advanced to reach position from primary importance relative to tibia main body after being configured to carry out osteotomy between tuberosity bone and tibia main body by these TTA reach assembly.In one embodiment, what TTA moved forward that assembly comprises the reach main body that is configured to be connected to tibia main body and be connected to the main body that moves forward movingly struts arm.Strut arm to be configured to be connected to tuberosity bone, and be configured to translation to move together with tuberosity bone relative to tibia main body, make to strut arm relative to the predetermined distance of reach bulk motion.Strut the predetermined distance of arm translation, make reach assembly provide tuberosity bone to be advanced to the instruction of reach position from primary importance.

In one embodiment, TTA reach assembly comprises the reach main body being configured to be connected to tibia main body; And be connected to the angular adjustment component of reach main body pivotally.Angular adjustment component is configured to relative to reach main body around pivot axis, and comprises the contact member being configured to be engaged in gap that osteotomy limits.Angular adjustment component be configured to relative to reach main body fix pivotally, make when contact member is arranged in osteotomy, move forward main body relative to osteotomy with predetermined reach angular orientation.

The disclosure also relates to the TTA method for tuberosity bone to be advanced to relative to tibia main body reach position after carrying out osteotomy between tuberosity bone and tibia main body from primary importance.In one embodiment, one or more during TTA method comprises the following steps: reach main body is connected to tuberosity bone by the arm that struts a) by being connected to reach main body movingly, strut arm and are configured to relative to the main body translation that moves forward; B) be positioned in the gap formed during osteotomy by the contact member being connected to reach main body, this gap is arranged between tuberosity bone and tibia main body; C) make to strut arm relative to reach bulk motion, move between primary importance and reach position to make tuberosity bone.

Accompanying drawing explanation

When composition graphs solution accompanying drawing is read, aforementioned summary and following detailed description of the preferred embodiment will be understood better.For illustrating object of the present invention, accompanying drawing illustrates presently preferred embodiment.But, the invention is not restricted to concrete means disclosed in accompanying drawing.In the accompanying drawings:

Fig. 1 is the illustration of the healthy knee of Canis animals;

Fig. 2 is the side front view being such as implanted to the tibial tubercle sacrolisthesis system of the routine in knee shown in Fig. 1 in response to the damage of knee anterior cruciate ligament;

Fig. 3 is the perspective view at least partially of tibial tubercle sacrolisthesis (TTA) system according to embodiment of the present disclosure, and this TTA system comprises distance piece, distance piece fixed component and implant;

Fig. 4 A is the perspective view of the distance piece according to embodiment of the present disclosure;

Fig. 4 B is the anterior elevational view of distance piece shown in Fig. 4 A;

Fig. 4 C is the top view of distance piece shown in Fig. 4 A;

Fig. 4 D is the sectional side view of distance piece shown in Fig. 4 A of intercepting along hatching 4D-4D;

Fig. 4 E is the profile of distance piece shown in Fig. 4 A of intercepting along hatching 4D-4D;

Fig. 4 F is the perspective view of the distance piece according to an embodiment;

Fig. 4 G is the perspective view of the distance piece according to another embodiment;

Fig. 4 H is the perspective view of the distance piece according to another embodiment;

Fig. 4 I is the perspective view of the distance piece according to another embodiment;

Fig. 4 J is the perspective view of the distance piece according to another embodiment;

Fig. 4 K is the perspective view of the distance piece according to another embodiment;

Fig. 4 L is the perspective view of the distance piece according to another embodiment;

Fig. 5 A is the perspective view of the fixed component of distance piece shown in Fig. 3;

Fig. 5 B is the perspective view of the distance piece fixed component according to another embodiment;

Fig. 6 A is the decomposition diagram of the distance piece according to another embodiment, the distance piece fixed component shown in Fig. 5 B and securing member;

Fig. 6 B is the perspective view of the distance piece shown in Fig. 6 A, distance piece fixed component and the securing member be connected to each other;

Fig. 6 C is the anterior elevational view of distance piece shown in Fig. 6 A;

Fig. 7 A is the perspective view of distance piece according to an embodiment and securing member;

Fig. 7 B is the anterior elevational view of distance piece and securing member shown in Fig. 7 A;

Fig. 8 A is the perspective view being configured to guide arrangement for guiding, the distance piece shown in Fig. 3, the distance piece fixed component shown in Fig. 3 and the implant shown in Fig. 3 that tuberosity bone photo moves forward for tibia main body, and wherein arrangement for guiding is connected to reach tuberosity bone and tibia main body;

Fig. 8 B is the perspective view of arrangement for guiding shown in Fig. 8 A;

Fig. 8 C is the decomposition diagram of arrangement for guiding shown in Fig. 8 A;

Fig. 9 is a kind of for measuring the schematic diagram of tuberosity bone photo for the common tangent method of the longitudinal direction of tibia main body and angle reach;

Figure 10 A is the top rear perspective view of the implant according to another embodiment;

Figure 10 B is the bottom front perspective view of implant shown in Figure 10 A;

Figure 10 C be in the first orientation Figure 10 A shown in the left side elevation view of implant;

Figure 10 D is the right side elevation view of implant shown in Figure 10 A;

Figure 10 E be in the second orientation Figure 10 A shown in the left side elevation view of implant;

Figure 10 F is the top plan view of implant shown in Figure 10 A;

Figure 10 G is the bottom plan view of implant shown in Figure 10 A;

Figure 10 H is the anterior elevational view of implant shown in Figure 10 F on online 10H direction;

Figure 10 I is the rear front view of implant shown in Figure 10 F on online 10I direction;

Figure 11 A is the top rear perspective view of the implant according to another embodiment;

Figure 11 B is the bottom front perspective view of implant shown in Figure 11 A;

Figure 11 C be in the first orientation Figure 11 A shown in the left side elevation view of implant;

Figure 11 D is the right side elevation view of implant shown in Figure 11 A;

Figure 11 E be in the second orientation Figure 11 A shown in the left side elevation view of implant;

Figure 11 F is the top plan view of implant shown in Figure 11 A;

Figure 11 G is the bottom plan view of implant shown in Figure 11 A;

Figure 11 H is the anterior elevational view of implant shown in Figure 11 F on online 11H direction;

Figure 11 I is the rear front view of implant shown in Figure 11 F on online 11I direction.

Detailed description of the invention

Some term used in following description only for convenience's sake and and nonrestrictive.Vocabulary " right side ", " left side ", D score and " on " specify direction in the accompanying drawing of institute reference.Vocabulary " inner side " and " outside " refer to respectively towards with away from the direction extending through main body center line, such as extend to afterbody from the head of Canis animals health.Vocabulary " nearside " and " distally " refer to towards or away from adnexa join to health all the other residing for the direction of position.Optimum position in the Canis animals health of vocabulary "front", "rear", " dorsal part ", " veutro " and relevant vocabulary and/or the reference of phrase appointment institute and orientation, the property processed and not intended to be is limited.Such as, " front " and " afterwards " refers to the position closer to head and afterbody respectively.And " dorsal part " and " veutro " refers to the position closer to spinal column and abdominal part respectively.These terms comprise above enumerate vocabulary, they derivative and there is the vocabulary of similar meaning.Such as, as shown in Figure 8 A, arrow 60 can represent nearside, dorsal part or direction upward.Arrow 62 can represent distally, veutro or direction down.Arrow 64 can represent front, towards front side or front direction.Arrow 66 can represent tail side, rear or after direction.Outside arrow 68 can represent or away from direction.Arrow 70 can represent inner side or direction.

See Fig. 3, tibial tubercle sacrolisthesis (TTA) system 100 can be configured to the anterior cruciate ligament deficiency patella in stable quadruped.In one embodiment, TTA system 100 comprises for quadruped implant 104, such as tibial tubercle sacrolisthesis (TTA) implant.Implant 104 can be constructed to bone fixed component 106, such as hone lamella 108.In the embodiment depicted, implant 104 comprises implant main body 110, the middle implant part 116 that this implant main body 110 comprises proximal part 112, oppositely distal portions 114 and is arranged between proximal part 112 and distal portions 114.

The proximal part 112 of implant main body 110 can be configured to be attached to tuberosity bone 30, and this tuberosity bone 30 is being advanced to from primary importance the position that moves forward relative to tibia main body 23 together with kneecap tendon 32 (shown in Fig. 1) on the direction of front side.The distal portions 114 of implant main body 110 can be configured to be attached to tibia main body 23.Be to be understood that, kneecap tendon 32 is attached to tuberosity bone 30 at anatomy attachment location 43 place, and tuberosity bone 30 can be excised, therefore tuberosity bone 30 separates with tibia main body 23 in the position of attachment location 43 tail side, makes kneecap tendon 32 (comprising attachment location 43) be advanced to from primary importance the position that moves forward together with the tuberosity bone 30 separated.Proximal part 112, distal portions 114 and middle implant part 116 can be totally monomer structure.Alternatively, proximal part 112, distal portions 114 and middle implant part 116 can be the discrete parts being connected to each other to form implant main body 110.

Proximal part 112 can become profile and be configured to conform to medial surface or the lateral surface of tuberosity bone 30, so that implant 104 is attached to tuberosity bone 30.In addition, proximal part 112 comprises one or more attachment location, such as fastener hole.In the embodiment depicted, the proximal part 112 of implant main body 110 comprises four fastener hole 118a, 118b, 118c and 118d.But proximal part 112 can comprise more or less fastener hole.Do not consider the concrete number of fastener hole, each fastener hole 118a, 118b, 118c and 118d extend through implant main body 110, and are configured and size is set to receive and implant 104 can be attached to the securing member 120 of tuberosity bone 30, such as bone anchor.

The example of suitable securing member 120 includes but not limited to bone screw, nail, pin and is configured to implant 104 to be attached to any miscellaneous equipment of tuberosity bone 30.Such as, fastener hole 118a, 118b, 118c and 118d can be the screwed hole being configured to receive bone screw.In addition, fastener hole 118a, 118b, 118c and 118d can be the conical screw hole being configured to receive the bone screw with thread taper head.Securing member 120 is inserted through fastener hole 118a, 118b, 118c and 118d make proximal part 112 be attached to tuberosity bone 30.Fastener hole 118a, 118b, 118c and 118d can be spaced apart from each other and along the first longitudinal axes L 1 substantial alignment, this first longitudinal axes L 1 is arranged essentially parallel to the prolonging direction of tuberosity bone 30 when implant 104 is attached to reach tuberosity bone 30 and extends.In one embodiment, proximal part 112 can be longitudinally axis L1 elongation.

Distal portions 114 can become profile and be configured to conform to medial surface or the lateral surface of tibia main body 23, so that implant 104 is attached to tibia main body 23.In addition, the distal portions 114 of implant main body 110 can comprise one or more anchorage point, such as fastener hole.In the embodiment depicted, distal portions 114 comprises the first fastener hole 122a and the second fastener hole 122b.Each also size that is configured in fastener hole 122a and 122b is set to the securing member 124 receiving and implant 104 can be attached to tibia main body 23, such as bone anchor.

The example of suitable securing member 124 includes but not limited to bone screw, nail, pin and is configured to implant 104 to be attached to any miscellaneous equipment of tibia main body 23.Securing member 124 is inserted through fastener hole 122a and 122b and makes distal portions 114 be attached to tibia main body 23.Fastener hole 122a and 122b can be spaced apart from each other and along the second longitudinal axes L 2 substantial alignment.In one embodiment, distal portions 114 can be along second longitudinal axes L 2 extend.Second longitudinal axes L 2 angularly can be biased with the first longitudinal axes L 1.

The middle implant part 116 of implant main body 110 can be extends along the second longitudinal axes L 2.Alternatively, middle implant part 116 can be along the axis elongation be angularly biased with the second longitudinal axes L 2.Although the attachment location such as fastener hole in the not shown middle implant part 116 of accompanying drawing, it is envisaged that middle implant part 116 can comprise one or more fastener hole or other suitable attachment features structure any.Middle implant part 116 extends between proximal part 112 and distal portions 114, and by molding, so that relative to distal portions 114, towards front side, tuberosity bone 30 is remained on the amount in reach position or distance by spaced apart being enough to by proximal part 112.

TTA system 100 also can comprise distance piece 102, and this distance piece 102 is configured to the distance kept when tuberosity bone 23 is in reach position between tibia main body 23 and tuberosity bone 30.Distance piece 102 can be configured and size is set in the osteotomy gap 40 being engaged at least in part and being defined between tibia main body 23 and reach tuberosity bone 30.In the embodiment depicted, distance piece 102 can be configured to support 126, as described in detail.

Except distance piece 102, TTA system 100 can comprise distance piece fixed component 128, and this distance piece fixed component 128 is configured to distance piece 102 is connected to tibia main body 23 and reach tuberosity bone 30, thus is fixed in osteotomy gap 40 by distance piece 102.As hereafter discussed in detail, distance piece fixed component 128 can be configured to hone lamella 130.Hone lamella 130 can be configured at least partially and size is set to and is inserted through distance piece 102.Distance piece fixed component 128 comprises main body 134, and it is also referred to as plate main body.The main body 134 of distance piece fixed component 128 can be elongation, and can limit first end part 138, the second end part 140 and be arranged on the intermediate fixed portion 142 (shown in Fig. 5 A) between first end part 138 and the second end part 140.

First end part 138 can be configured to be attached to reach tuberosity bone 30.For this reason, first end part 138 can become profile and be configured to conform to lateral surface or the medial surface of reach tuberosity bone 30, and can comprise one or more attachment location such as fastener hole 132.Fastener hole 132 can be configured and size is set to the securing member 136 receiving and distance piece fixed component 128 can be attached to reach tuberosity bone 30, such as bone anchor.Suitable securing member 136 includes but not limited to that first end part 138 maybe can be attached to other securing member 136 any of reach tuberosity bone 30 by bone screw, nail, pin.

The second end part 140 of main body 134 is configured to be attached to tibia main body 23.For this reason, the second end part 140 can become profile and be configured to conform to lateral surface or the medial surface of tibia main body 23, and can comprise one or more attachment location such as fastener hole 144.In the embodiment depicted, the second end part 140 only comprises a fastener hole 144; But it is envisaged that, the second end part 140 can limit more than one fastener hole 144.Fastener hole 144 can be configured and size is set to reception securing member 136, such as bone anchor.The example of securing member 136 includes but not limited to that the second end part 140 maybe can be attached to any miscellaneous equipment of tibia main body 23 by bone screw, nail, pin.

Intermediate fixed portion 142 is configured to the opening such as slit being inserted through distance piece 102, to be fixed in osteotomy gap 40 by distance piece 102 when first end part 138 is attached to reach tuberosity bone 30 and the second end is attached to tibia main body 23.In the embodiment depicted, intermediate fixed portion 142 can have substantially smooth configuration, as described in detail.First end part 138, the second end part 140 and intermediate fixed portion 142 can be monomer structure.Alternatively, first end part 138, the second end part 140 and intermediate fixed portion 142 can be the discrete parts be connected to each other.Intermediate fixed portion 142 can limit substantially smooth configuration, and this configuration is configured to be engaged in the slit of distance piece 102, as discussed below.

See Fig. 4 A-4E, distance piece 102 can comprise be configured and size be set to the distance piece main body 148 be engaged in osteotomy gap 40.Distance piece main body 148 can be longitudinally 150 to extend, and can limit the first longitudinal end 152 and longitudinally 150 and isolated second longitudinal end 154 of the first longitudinal end 152.In addition, distance piece main body 148 limits the first lateral end 156 and laterally 160 and isolated second lateral end 158 of the first lateral end 156.Side direction 160 is substantially perpendicular to longitudinal 150.

Particularly, distance piece main body 148 can have the first lateral ends 164 and transversely 162 and isolated second lateral ends 166 of the first lateral ends 164.Laterally 162 be substantially perpendicular to longitudinal 150 and side direction 160.In the embodiment depicted, distance piece main body 148 can limit the shape of part wedge shape substantially, and its width is increased on horizontal 162.The width of distance piece main body 148 is limited between the first lateral end 156 and the second lateral end 158.In the embodiment depicted, distance piece main body 148 can be limited to first width W 1 at the first lateral ends 164 place, and this width W 1 is greater than second width W 2 at the second lateral ends 166 place.The wedge-type shape of distance piece main body 148 is convenient to distance piece 102 to be inserted and positioned in osteotomy gap 40, this is because osteotomy gap 40 has the shape of wedge shape substantially.

Distance piece 102 also can comprise the opening 168 extending through distance piece main body 148 from the first longitudinal end 152 to the second longitudinal end 154.Therefore, opening 168 can be longitudinally 150 elongations.Opening 168 can be constructed to hole, and is configured to receive other natural or synthetic material any that bone graft maybe can promote osteogenesis.But opening 168 not necessarily must be filled with bone graft or other bone growth agent any.When distance piece 102 is arranged in osteotomy gap 40, opening 168 provides open space, grows to allow nature bone.At nature bone growing period, when distance piece 102 is arranged in osteotomy gap 40, nature bone can grow and fill opening 168 at least partially.

Distance piece 102 also limits the first slit 170, and this first slit 170 extends through distance piece main body 148 from the first lateral end 156 to the second lateral end 158.Therefore, the first slit 170 can be laterally 160 elongations.First slit 170 is oriented to compare the second longitudinal end 154 closer to the first longitudinal end 152, and is configured and size is set to and receives distance piece fixed component 128 at least partially, distance piece 102 is connected to distance piece fixed component 128.In the embodiment depicted, the first slit 170 can limit the plane being substantially perpendicular to longitudinally 150.Middle fixed component 142 can have substantially smooth configuration, makes it be configured to be engaged in the slit 170 of distance piece 102, thus distance piece 102 is connected to distance piece fixed component 128.

Except the first slit 170, distance piece 102 comprises at least one second slit 172, and this at least one second slit 172 extends through distance piece main body 148 from the second lateral end 156 to the second lateral end 158.In the embodiment depicted, distance piece 102 limits longitudinally 150 multiple second slits 172 be spaced apart from each other.At least one in second slit 172 is oriented to compare the first longitudinal end 152 closer to the second longitudinal end 154.Each restriction in second slit 172 is relative to longitudinally 150 with the plane of angle of inclination orientation.In use, the second slit 172 is configured to receive other natural or synthetic material any that bone graft maybe can promote osteogenesis.Second slit 172 not necessarily must be filled with bone graft or other bone growth agent any.On the contrary, when distance piece 102 is arranged in osteotomy gap 40, the second slit 172 provides open space, grows to allow nature bone.

At nature bone growing period, when distance piece 102 is arranged in osteotomy gap 40, nature bone can grow and fill the second slit 172 at least partially.Second slit 172 is also convenient to cut distance piece 102.As hereafter discussed in detail, distance piece 102 can be cut to reduce its length 174, and this length 174 is limited by the distance longitudinally between 150 first longitudinal ends 152 and the second longitudinal end 154.In operation, the length 174 of distance piece 102 may must be shortened, and can be engaged in rightly in osteotomy gap 40 to make distance piece 102.For this reason, each also size that is configured in the second slit 172 is set to that receiving cutting tool such as saws at least partially.In operation, saw one that can be inserted through in slit 172, to cut distance piece 102, thus shorten its length 174.The material that distance piece 102 also can partially or even wholly be cut by the such as sawing of available cutting tool is made.Distance piece 102 also can comprise multiple pointed tooth 173.At least some in pointed tooth 173 is arranged between two slits 172.Pointed tooth 173 can have substantially smooth configuration.In the embodiment depicted, pointed tooth 173 is relative to the angles of longitudinally 150 one-tenth inclinations.Distance piece 102 can be partially or even wholly made up of any suitable biocompatible materials such as polyether-ether-ketone (PEEK).

A part for the external member comprising the distance piece with different size is can be see Fig. 4 F-L, TTA system 100.Therefore, this external member can comprise the distance piece with different length, height and width.Such as, external member can comprise distance piece 102a, 102b, 102c, 102d, 102e, 102f and 102g.Except their size, distance piece 102a, 102b, 102c, 102d and 102e are substantially similar to above about the distance piece 102 described in Fig. 4 A-E.Therefore, distance piece 102g and 102f is substantially similar to above about the distance piece 102 described in Fig. 4 A-E; But due to size restriction, distance piece 102g and 102f does not comprise the opening of the opening 168 as distance piece 102.In addition, distance piece 102g and 102f is less than above about the distance piece 102 described in Fig. 4 A-E.

See Fig. 5 A, distance piece fixed component 128 is configured to distance piece 102 is connected to tibia main body 23 and reach tuberosity bone 30, to be fixed in osteotomy gap 40 by distance piece 102.In the embodiment depicted, distance piece fixed component 128 can be configured to hone lamella 130, and comprise be configured and size be set to the main body 134 be partly engaged in the first slit 170 of distance piece 102.Main body 134 also can be called as plate main body.In addition, main body 134 intermediate fixed portion 142 that can limit first end part 138, the second end part 140 and be arranged between first end part 138 and the second end part 140.

First end part 138 can be longitudinally axis 176 elongation, and can be configured to be attached to reach tuberosity bone 30.For ease of the attachment between distance piece fixed component 128 and reach tuberosity bone 30, first end part 138 can become profile and be configured to conform to lateral surface or the medial surface of reach tuberosity bone 30, and can comprise one or more attachment location such as fastener hole 132.Fastener hole 132 can be configured and size is set to reception securing member 136, as discussed above.In the embodiment depicted, first end part 138 limits multiple fastener hole 132.Multiple fastener hole 132 allows user at the different attachment location places along first end part 138, distance piece fixed component 128 to be attached to reach tuberosity bone 30.But expection first end part 138 only can limit a fastener hole 132.

Intermediate fixed portion 142 can be that longitudinally axis 176 extends and can limit at least one fastener hole 178, and this fastener hole 178 is configured to receive securing member, such as bone anchor.If needed, distance piece fixed component 128 can be cut to be shortened, and securing member can be inserted through fastener hole 178 and enter in tibia main body 23, so that distance piece fixed component 128 is connected to tibia main body 23.As discussed above, can being configured at least partially in insertion first slit 170 of intermediate fixed portion 142, to be connected to distance piece 102 by distance piece fixed component 128.

The second end part 140 can be longitudinally axis 178 elongation, and this longitudinal axis 178 is angularly biased relative to longitudinal axis 176.In one embodiment, the second end part 140 can become profile and be configured to conform to lateral surface or the medial surface of tibia main body 23.For ease of the attachment between distance piece fixed component 128 and tibia main body 23, the second end part 140 can comprise one or more attachment location such as fastener hole 144.In the embodiment depicted, the second end part 140 only limits a fastener hole 144.But the second end part 140 can comprise more than one fastener hole 144.As discussed above, securing member can be inserted through fastener hole 144 and enter in tibia main body 23, so that distance piece fixed component 128 is connected to tibia main body 23.

See Fig. 5 B, another embodiment distance piece fixed component 128a is substantially similar to above about the distance piece fixed component 128 described in Fig. 5 A.But in this embodiment, the second end part 140a comprises the first section 141a, this Part I 141a is connected to intermediate fixed portion 142a and longitudinally axis 177a extends.Longitudinal axis 177a can be substantially perpendicular to longitudinal axis 176a.The second end part 140a also comprises Part II 143a, and this Part II 143a is that longitudinally axis 179a extends.Longitudinal axis 179a angularly can be biased relative to longitudinal axis 177a and longitudinal axis 176a.In operation, the second end part 140a of distance piece fixed component 128a can become profile and be configured to conform to lateral surface or the medial surface of tibia main body 23, so that distance piece fixed component 128a is connected to this lateral surface or medial surface.

See Fig. 6 A-6C, can be positioned in osteotomy gap 40 according to the distance piece 202 of another embodiment, tuberosity bone 30 is remained in reach position relative to tibia main body 23.Distance piece 202 can comprise distance piece main body 248, and this distance piece main body 248 can be partially or even wholly made up of polyether-ether-ketone (PEEK) or other suitable material any.Distance piece main body 248 limit upper surface 203 and back to lower surface 205.Upper surface 203 transversely 262 with lower surface spaced apart.Distance piece main body 248 can comprise front surface 207 and back to rear surface 209.Rear surface 209 can longitudinally 250 with front surface 207 spaced apart.Distance piece main body 248 can limit the first side surface 211 and the second side surface 213.Second side surface 213 can laterally 260 and first side surface 211 spaced apart.

Distance piece 202 also limits multiple slit 272, and these slits 272 extend in the lower surface of distance piece main body 248.Slit 272 can laterally 260 be spaced apart from each other.Each in slit 272 can be and transversely 262 to extend.In addition, each in slit 272 can extend through distance piece main body 248 from front surface 207 to rear surface 209.When distance piece 202 is arranged in osteotomy gap 40, slit 272 provides open space, to allow osteogenesis.Slit 272 is also convenient to the cutting of distance piece 202, to shorten its length.In addition, when distance piece 202 is arranged in osteotomy gap 40, any suitable natural or synthetic bone growth material can be arranged in slit 272, to promote osteogenesis.Slit 272 is also convenient to the cutting of distance piece 202.As discussed above, if needed, distance piece 202 can be cut make it be engaged in rightly in osteotomy gap 40.Such as, cutting tool can be inserted through one in slit 272, to cut distance piece 202, thus laterally 260 shorten distance pieces 202.

Distance piece main body 248 can comprise the laterally 260 multiple resilient tines 275 be spaced apart from each other.Each resilient tines 275 is arranged between two slits 272.When distance piece 202 is arranged in osteotomy gap 40, resilient tines 275 allows laterally 260 compression distance piece main bodys 248, to allow the shape conforming to osteotomy gap 40 at least partially of distance piece main body 248.Resilient tines 275 also can have different length, to limit curved bottom lower surface 205.Particularly, resilient tines 275 can limit recessed lower surface 205, and when distance piece 202 is arranged in osteotomy gap 40, this recessed lower surface 205 allows tooth 275 to be pressed against each other, to conform to the shape in osteotomy gap 40.

Distance piece 202 also can comprise and laterally 260 enters one or more holes 270 in distance piece main body 248.In the embodiment depicted, hole 270 laterally 260 extends through distance piece main body 248 from the first side surface 211 to the second side surface 213.When distance piece 202 is arranged in osteotomy gap 40, hole 270 provides open space, to promote osteogenesis.Except hole 270, distance piece 202 also limits the one or more ridges 273 extended in upper surface 203.In the embodiment depicted, ridge 273 can laterally 260 be spaced apart from each other.Ridge 273 can be longitudinally 250 elongations.In operation, cutting tool is such as sawed in one that can insert in ridge 273 to cut distance piece 202.Therefore, ridge 273 is convenient to the cutting of distance piece 202.Ridge 273 also allows distance piece 202 to bend.

Distance piece 202 also can limit and to be configured and size is set to and receives at least one fastener hole 215 of securing member 133.Securing member 133 can be configured to distance piece fixed component 128a (or other distance piece fixed component any) to be connected to distance piece 202.In the embodiment depicted, securing member 133 is configured to screw, and fastener hole 215 can be screwed hole.But it is envisaged that, securing member 133 can be configured to any miscellaneous equipment following closely, sell or be configured to distance piece fixed component 128 to be connected to distance piece 202.In order to distance piece fixed component 128a is connected to distance piece 202, securing member 133 can be inserted through in the fastener hole 132a of distance piece fixed component 128a and enter in fastener hole 215.As discussed above, distance piece fixed component 128a is also connected to reach tuberosity bone 30 and tibia main body 23 by securing member.

See Fig. 7 A-B, can be positioned in osteotomy gap 40 according to the distance piece 302 of another embodiment, tuberosity bone 30 is remained in reach position relative to tibia main body 23.Distance piece 302 is substantially similar to distance piece 202.But in this embodiment, resilient tines 375 has substantially similar or identical length, and therefore, do not limit recessed lower surface 305.On the contrary, lower surface 205 can have substantially smooth configuration.In addition, distance piece 302 also can limit the groove 371 extended in lower surface 305, such as partial hole.Groove 371 can longitudinally 350 be spaced apart from each other.In operation, when distance piece 302 is arranged in osteotomy gap 40, groove 371 provides open space, to allow osteogenesis.

Also can comprise TTA reach assembly 400 see Fig. 8 A-C, TTA system 100, this reach assembly 400 is configured to guiding tuberosity bone 30 and moves forward relative to tibia main body 23.As hereafter discussed in detail, can be used for hereafter describing in detail relative to the move forward reach assembly 400 of tuberosity bone 30 of tibia main body 23.Reach assembly 400 comprises reach component 402, and this reach component 402 is configured to be connected to implant 104, and this implant 104 is connected to tuberosity bone 30 then.Particularly, the component 402 that moves forward can be connected to the proximal part 112 of implant 104.In the embodiment depicted, the attachment location place that the component 402 that moves forward can limit at fastener hole 118a is connected to implant 104.Implant 104 can be attached to tuberosity bone 30 and reach component 402.Therefore, reach component 402 can be handled, with the tuberosity bone 30 (by implant 104) that moves forward relative to tibia main body 23.

Continue see Fig. 8 A-C, reach component 402 can be configured to fixture 403, and can comprise reach main body 404.Reach main body 404 can be configured to jig main body or framework.Regardless of its configuration, reach main body 404 limits attachment location, is such as configured to the shift scale hole 406 receiving shift scale 408 securely.Therefore, reach assembly 400 can comprise shift scale 408, and this shift scale 408 can be used for measuring the length travel of tuberosity bone 30 relative to tibia main body 23.Shift scale 408 can be attached to reach main body 404 removedly by shift scale hole 408.

Shift scale 408 comprises main body 410, and this main body 410 comprises and can be used for measuring the measurement markers 412 of tuberosity bone 30 relative to the length travel of tibia main body 23.Except main body 410, shift scale 408 comprises from the outstanding connecting elements 414 of main body 410.Connecting elements 414 can be configured to cardinal principle column and can be arranged on removedly in shift scale hole 406.Connecting elements 414 can comprise the ring 418 connecting main body 416 and arrange around connection main body 416.Connect main body 416 to be configured and size is set to and is received at least in part in shift scale hole 406.When connecting elements 414 is at least partially disposed in shift scale hole 406, the adjacent inner surface limiting the reach main body 404 of displacement staff guage hole 406 of ring 418, thus frictional fit connection is set up between connecting elements 414 and reach main body 404.

Reach assembly 400 also can comprise longitudinal traction mechanism 419, and this longitudinal traction mechanism 419 is configured to relative to tibia main body 23, tuberosity bone 30 be moved when the assembly 400 that moves forward is connected to tuberosity bone 30 and tibia main body 23.In the embodiment depicted, haulage gear 419 can comprise be movably coupled to reach main body 404 strut arm 420 and actuator 424 such as knob 426.In operation, strut arm 420 to be configured to move relative to reach main body 404 when actuated actuators 424.Therefore, the actuating of actuator 424 makes to strut arm 420 and longitudinally draws axis 422 relative to reach main body 404 and move.In operation, when the assembly 400 that moves forward is connected to tuberosity bone 30 and tibia main body 23, struts arm 420 and relative to the motion of reach main body 404, tuberosity bone 30 is moved relative to tibia main body 23.

As discussed above, actuator 424 can be configured to knob 426.Knob 426 can comprise knob body 428, and can limit and to be configured and size is set to receive and struts the screwed hole 430 at least partially of arm 420.Screwed hole 430 can extend across knob body 428.Strut arm 420 and can comprise external screw-thread 432, these external screw-threads 432 are configured to and the screw-internal thread fit arranged around screwed hole 430, make knob 426 cause strutting arm 420 around the rotation strutting arm 420 and longitudinally draw axis 422 relative to knob 426 and move.Therefore, strut arm 420 can be configured to move relative to reach main body 404 when rotary knob 426.Although strutting arm 420 can relative to the lengthwise movement of reach main body 404, knob 426 is longitudinally fixing relative to reach main body 404.

Reach component 402 can comprise the first attachment contact pin 436 and the second attachment contact pin 438, and they are spaced apart from each other to limit knob passage 434.First attachment contact pin 436 and the second attachment contact pin 438 can be given prominence to from reach main body 404.Knob passage 434 can be configured and size is set to reception knob 426, knob 426 is longitudinally fixed to reach component 402, allows knob 426 to rotate in knob passage 434 simultaneously.Knob 426 can be configured to rotate around longitudinal traction axis 422.First attachment contact pin 436 limits and struts arm aperture 440, and this struts arm aperture 440 and is configured to receive and struts arm 420 at least partially.Strut arm 402 to can be slid through and strut arm aperture 440.Second attachment contact pin 438 can limit and struts arm passage 442, and this struts arm passage 442 and to be configured and size is set to receive and struts arm 420 at least partially.Strut arm 420 to can be slid through and strut arm passage 442.Second contact pin 438 also can limit the first stopper element 444, and this first stopper element 444 is configured to adjacent the second stopper element 446 strutting arm 420, so that restriction struts the lengthwise movement of arm 420 relative to reach component 402.

Strut arm 420 and can limit first end 448 and the second end 450, the second end 450, as shown in illustrative embodiment, can limit the second stopper element 446 then.It is spaced apart with the second end 450 that first end 448 longitudinally can draw axis 422.Strut arm 420 and also can limit the brill guide hole 452 extending through the second end 450 strutting arm 420.Brill guide hole 452 can be configured and size is set to that conductor 454 is bored in reception, and this brill conductor 454 can be configured to sleeve.Bore conductor 454 and can comprise brill conductor main body 456, this brill conductor main body 456 limits the first end 460 and the second end 462 that are spaced apart from each other.

The second end 462 can limit threaded tip 464, and this threaded tip 464 is configured and size is set to and coordinates with the threaded fastener hole 118a (Fig. 3) of implant 404, brill conductor 454 is connected to implant 104.Threaded tip 464 can have frustoconical shape.Bore conductor 454 and can limit brill conductor opening 458, this brill conductor opening 458 extends through the brill conductor main body 456 between first end 460 and the second end 462.Brill conductor opening 458 can be configured and size is set to reception drill bit or temporary fixed component such as wire rod 466.Wire rod 466 can be Kirschner wire (Kirschner wire), and is configured to be inserted through brill conductor opening 458 and enter tuberosity bone 30, bores when conductor 454 is connected to and struts arm 420 reach assembly 400 is connected to tuberosity bone 30 with box lunch.

Reach assembly 400 also can comprise angle adjusting mechanism 468, and this angle adjusting mechanism 468 is configured to regulate tuberosity bone 30 relative to the angle position of tibia main body 23 when the assembly 400 that moves forward is connected to tibia main body 23 and tuberosity bone 30.In the embodiment depicted, angle adjusting mechanism 468 can comprise the angular adjustment component 470 being movably coupled to reach main body 404.Particularly, angular adjustment component 470 is configured to rotate around the attachment location limited along pivot axis R.Particularly, the component 402 that moves forward limits attachment location such as hole 472.Hole 472 extends through reach main body 404 along pivot axis R, and is configured to receive revolving actuator 474 at least partially, makes revolving actuator 474 be configured to rotate in hole 472 around pivot axis R.

Revolving actuator 474 can be configured to knob 473 and comprise attachment members 476, and this attachment members 476 is configured to coordinate with the attachment members 480 of angular adjustment component 470, revolving actuator 474 is connected to angular adjustment component 470.Attachment members 476 can be configured to external screw-thread main body 478, and attachment members 480 can be configured to screwed hole 482.Screwed hole 482 can be configured to coordinate with external screw-thread main body 478, revolving actuator 474 is connected to angular adjustment component 470.Angular adjustment component 470 can be configured to angle scale.

Also by tightening revolving actuator 474 relative to angle main body 404 angularly fixed angle adjustment means 470.Such as, revolving actuator 474 tightens the threaded body 478 in screwed hole 482 around pivot axis R rotation in a first direction, thus relative to reach main body 404 angularly fixed angle adjustment means 470.On the contrary, revolving actuator 474 unclamps around pivot axis R rotation in the second direction opposite to the first direction the external screw-thread main body 478 be arranged in screwed hole 482, thus allows angular adjustment component 470 to rotate around pivot axis R relative to reach main body 404.

Angular adjustment component 470 comprises the longitudinally 486 angle scale main bodys 484 of extending.Angle scale main body 484 can have substantially smooth configuration, and limits the first scale end 488 and the second scale end 490.Second scale end 490 longitudinally 486 and first scale end 488 spaced apart.Screwed hole 482 can be positioned on the first scale end 488 place or near.Angular adjustment component 470 also can comprise laterally 492 contact members 494 given prominence to from angle scale main body 484.Side direction 492 can be substantially perpendicular to longitudinal 486.Contact member 494 can have substantially smooth configuration, and is configured and size is set to and is arranged in osteotomy gap 40.Contact member 494 can be support, blade and is maybe suitable for contact tibial tubercle bone 30, tibia main body 23 or both any equipment when being positioned in osteotomy gap 40.

Angular adjustment component 470 also can comprise the angle mark 491 arranged along the second scale end 490.Angle mark 491 helps user to measure the angular orientation of contact member 494 relative to reach main body 404.Particularly, angle mark 491 is arranged along arc, and the center of this arc is limited by attachment members 480.Angular adjustment component 470 also comprises multiple opening or the groove 496 of adjacent corners scale designation 491 setting.Opening 496 is spaced apart from each other along arc, and the center of this arc is limited by attachment members 480.Each also size that is configured in opening 496 is set to reception pillar 498, and this pillar 498 is given prominence to from reach main body 404 in side direction 492.Joint between pillar 498 and each opening 496 allows user with the angular orientation of predetermined up regulation angular adjustment component 470.

Angular adjustment component 470 also limits laterally 492 arc openings 499 extending through angle scale main body 484.Arc opening 499 can be along arc extend, the center of this arc is limited by attachment members 480.In the embodiment depicted, arc opening 499 is configured also size and is set to the provisional fixed component of reception such as wire rod 497.Wire rod 497 can be Kirschner wire, and is configured to the opening 495 being inserted through arc opening 499, reach component 402, and enters a tibia main body 23 such as tibia backbone's part, reach assembly 400 is connected to tibia main body 23.As discussed above, the component 402 that moves forward is limited to the opening 495 side direction 492 extending through reach main body 404.Opening 495 and arc opening 499 substantial alignment, and can be configured and size is set to and receives wire rod 497.When using TTA system 100, user such as surgeon can observe its action along view direction 72.Therefore, when using TTA system 100, the sight line of user extends along view direction 72.

See Fig. 9, conventional common tangent method can be used to measure tuberosity bone 30 relative to the longitudinal direction of tibia main body 23 and angle reach.Common tangent method performs by the processor in computer.Alternatively, common tangent method performs by being placed on by transparent overlay above X-ray film.All or some during the example of common tangent method comprises the following steps.First, the articular surface around femur 24 draws the first circle 502.Articular surface around tibia 22 draws the second circle 504.

First circle 502 should contact with the second circle 504, such as, make the first round 502 and second circle 504 tangent to each other.Then, the line 506 at the center 508 of connection first circle 502 and the center 510 of the second circle 504 is drawn.Then, common tangent CTL is drawn.Line CTL and first circle 502 and the second circle 504 tangent and perpendicular to line 506.Line CTL represents the gradient of tibial plateau 28 and the direction of front tibia thrust.

Then, the length of kneecap tendon 32 (shown in Fig. 1) is measured.The length of kneecap tendon 32 is limited to kneecap tendon 32 and originates between the position that in the distal pole P of patella 511 wherein and tuberosity bone 30, kneecap tendon 32 inserts.The position that kneecap tendon 32 inserts in tuberosity bone 30 is called insertion point I in the disclosure.The length of kneecap tendon 32 then can be recorded as distance PI.Then, line 512 is drawn to determine impact point T from the distal pole P of patella 511.Line 512 is perpendicular to line CTL and have the length equaling distance PI.Impact point T is the desired locations at the posterior tubercle bone 30 performing TTA operation.That is, when tibial tubercle bone 30 is fixed on impact point T, when weight is applied to knee joint 20, shin stock shearing is neutralized, thus reduces or avoid completely the anatomy function of CCL.

Then, osteotomy line 514 is identified.Osteotomy line 514 can be arranged on gerdy's tubercle (Gerdy ' sTubercle) (that is, the lateral tubercle of tibia) to tibial tubercle bone 30 distally between.Measure from insertion point I to the distance D1 of the most proximal end of osteotomy line 514.Measure from insertion point I to the distance D2 of the distalmost end of osteotomy line 514.Then, line TI is drawn from impact point T to insertion point I.Line TI can then extend to osteotomy line 514.Measure from impact point T to the forward pitch of insertion point I from AD.Then, reach angle A A is measured by the acute angle between slotted line TI and osteotomy line 514.

Then, in a computer, above the virtual representation dummy model of implant 104 being placed on tibia 22 and femur 24, to measure the just size of implant 104.Alternatively, by will the size measuring implant 104 above the actinogram that the lamination of implant 104 is placed on tibia 22 and femur 24 be represented.In the process, the proximal part 112 of implant 104 should be parallel to the forward edge of tuberosity bone.In addition, in the process, fastener hole 118a should be placed on predetermined distance (such as, about 1 millimeter to the 2 millimeters) place of I tail side, insertion point by TI along the line.Above-mentioned steps may be defined as preoperative plan.

Once complete preoperative plan, just osteotomy can be performed.Particularly, osteotomy can be carried out according to above-mentioned preoperative plan from the distally of tibial tubercle bone.Any suitable cutting tool can be utilized to carry out osteotomy.But, stop osteotomy at the predetermined distance of nearside cortex (such as, about 3 millimeters to the 4 millimeters) place from tibial tubercle bone 30.

See Fig. 8 A-9, after partly performing osteotomy, bore conductor 454 and be inserted through brill guide hole 452 at least in part.Then, the second end 462 boring conductor 452 is fixed in the fastener hole 118a of implant 104, as above-detailed.Then relative to reach main body 404 anglec of rotation adjustment means 470, pillar 498 and the label alignment equaling predetermined reach angle A A is made.Then by revolving actuator 474 being tightened in screwed hole 482 come as mentioned above relative to reach main body 404 fixed angle adjustment means 470.

Contact member 494 is inserted in osteotomy, then blade is moved in osteotomy further, be arranged on above insertion point I as determined in preoperative plan until strut arm 420.Then wire rod 466 is inserted through and bores conductor 454 and fastener hole 118a, and enter in tibial tubercle bone 30, reach assembly 400 and implant 104 are fixed to tibial tubercle bone 30.Wire rod 466 should in side direction 492 orientation.Then, wire rod 497 can be inserted through opening 495 and arc opening 499 and enter in a tibia main body 23 such as tibia backbone's part, reach assembly 400 is fixed to tibia main body 23.Actuated actuators 424, moves to make strutting arm 420 towards tibia main body 23, to compress osteotomy, until feel light resistance.Make to strut arm 420 by turning knob 426 tibia tomorrow main body 23 in a first direction to move.Now, user should record relative to the position of the labelling 412 of shift scale 408 starting point strutting arm 420 by writing down the first end 448 strutting arm 420.Then as the preoperative determined implant 104 that makes in the works is alignd with the front side of tibial tubercle bone 30, and securing member can be inserted at least one in fastener hole 118b, 118c or 118d, rotate to prevent implant 104.

Alternatively, by performing following steps, reach assembly 400 and implant 104 are connected to tibial tubercle bone 30 and tibia main body 23.First, can be identical with boring conductor 454 first bore conductor and insert in fastener hole 118a at least in part, brill conductor 454 is connected to implant 104.Then according to preoperative plan, implant 104 is placed on tibial tubercle bone 30.Then, wire rod 466 is inserted through and bores conductor 454 and enter in tibial tubercle bone 30, continue make the first brill conductor 454 be connected to implant 104 and keep implant 104 against tibial tubercle bone 30 simultaneously.Rotate implant 104, make the proximal part 112 of implant 104 be arranged essentially parallel to the forward edge of tuberosity bone.

Then can be identical with boring conductor 454 second bores conductor and is inserted through fastener hole 118d, the second brill conductor is connected to implant 104 at fastener hole 118d place.Drill bit can be inserted through the second brill conductor and fastener hole 118d, to hole in tibial tubercle bone 30.Then securing member such as lock-screw is inserted in the hole got out in tibial tubercle bone 30.Then with the such as predetermined reach angle A A adjusting angle adjustment means 470 of preoperative plan.Then knob 473 is tightened with the angular orientation relative to reach main body 404 fixed angle adjustment means 470.Then the first brill conductor is made to depart from implant 104 and it be taken out from animal.Then, reach component 404 moves forward through wire rod 466, wire rod 466 is arranged on and bores in guide hole 452.Strut arm 420 movingly away from tibia main body 23, make contact member 494 to be inserted in osteotomy.Then contact member 494 is inserted in osteotomy.Then, wire rod 497 can be inserted through opening 495 and arc opening 499 and enter in a tibia main body 23 such as tibia backbone's part.

After reach assembly 400 and implant 104 are connected to tibial tubercle bone 30 and tibia main body 123, by cutting through the nearside cortex of tibial tubercle bone 30 to complete osteotomy always.Then make to strut arm 420 move (by actuator 424) equal the distance of forward pitch from AD away from tibia main body 23.Shift scale 408 can be used to measure the displacement strutting arm 420.For this reason, user can turning knob 426 gradually in a second direction, until the first end 448 strutting arm 420 moves as by being substantially equal to the distance of forward pitch from AD measured by labelling 412.Therefore, strutting the predetermined distance of arm 420 translation (that is, forward pitch is from AD) makes reach assembly 400 (such as shift scale 408) provide tuberosity bone to be advanced to the instruction of reach position from primary importance.

Then, rotate tibial tubercle bone 30 relative to tibia main body 23, until its far-end 31 contact tibia main body 23 restriction Fig. 9 shown in the surface 25 of far-end of osteotomy.Then securing member 124 be inserted through fastener hole 122a and 122b and enter in tibia main body 23, so that the distal portions 114 of implant 104 is connected to tibia main body 23.Then osteotomy gap 40 is measured, to determine suitable spacer dimensions and distance piece fixed component size.Then distance piece fixed component 128 is connected to distance piece 102, as mentioned above.

Then, then distance piece 102 is inserted in osteotomy gap 40 to confirm to have selected suitable size.Reach assembly 400 can be taken out, to expand work space from animal.If have selected correct distance piece 102, so cut distance piece 102 (if needs), it is conformed to the size in osteotomy gap 40.Then by securing member 136 being inserted through fastener hole 132 and entering in tibial tubercle bone 30 and by another securing member 136 is inserted through fastener hole 144 and enters in tibia main body 23, distance piece 102 and distance piece fixed component 128 to be fixed in osteotomy gap 40.If not yet removed from animal by reach assembly 400, reach assembly 400 so can be made to depart from tibial tubercle bone 30 and tibia main body 23 and it be removed from animal.

Tibial tubercle bone 30 and tibia main body 23 is departed to make reach assembly 400 by removing wire rod 466 and 497 respectively from tibial tubercle bone 30 and tibia main body 23.Once depart from, just reach assembly 400 can be removed from animal.Drill bit can be inserted through fastener hole 118a, to produce for the suitable boring of securing member 120.Then, securing member 120 can be inserted through fastener hole 118a and enter in tibial tubercle bone 30, so that implant 104 is fixed to tibial tubercle bone 30.If think necessary, other securing member 120 can be inserted through fastener hole 118b, 118c and 118d and enter in tibial tubercle bone 30 the firm connection be used between implant 104 and tibial tubercle bone 30.

See Fig. 3 and Figure 10 A-10I, in another embodiment, TTA system 100 can comprise the alternative embodiment of implant 104 (shown in Fig. 3), such as implant 604 (shown in Figure 10 A-10H).Implant 604 can be constructed to bone fixed component 606, such as hone lamella 608.In the embodiment depicted, implant 604 comprises implant main body 610, the middle implant part 616 that this implant main body 610 comprises proximal part 612, relative distal portions 614 and is arranged between proximal part 612 and distal portions 614.The proximal part 612 of implant main body 610 can be configured to be attached to tuberosity bone 30, and this tuberosity bone 30 is being advanced to from primary importance the position that moves forward relative to tibia main body 23 together with kneecap tendon 32 (shown in Fig. 1) on the direction of front side.The distal portions 614 of implant main body 610 can be configured to be attached to tibia main body 23.

Be to be understood that, kneecap tendon 32 is attached to tuberosity bone 30 at anatomy attachment location 43 place, and tuberosity bone 30 can be excised, therefore tuberosity bone 30 separates with tibia main body 23 in the position of attachment location 43 tail side, makes kneecap tendon 32 (comprising attachment location 43) be advanced to from primary importance the position that moves forward together with the tuberosity bone 30 separated.Proximal part 612, distal portions 614 and middle implant part 616 can be totally monomer structure.Alternatively, proximal part 612, distal portions 614 and middle implant part 616 can be the discrete parts being connected to each other to form implant main body 610.

Proximal part 612 can become profile and be configured to conform to medial surface or the lateral surface of tuberosity bone 30, so that implant 604 is attached to tuberosity bone 30.In addition, proximal part 612 comprises one or more attachment location, such as fastener hole.In the embodiment depicted, the proximal part 612 of implant main body 610 comprises four fastener hole 618a, 618b, 618c and 618d.But proximal part 612 can comprise more or less fastener hole.Each fastener hole 618a, 618b, 618c and 618d extend through implant main body 610, and are configured and size is set to receive and implant 604 can be attached to the securing member 120 of tuberosity bone 30, such as bone anchor.Fastener hole 618a, 618b, 618c and 618d can be the screwed hole being configured to receive bone screw.In another embodiment, fastener hole 618a, 618b, 618c and 618d can be the conical screw hole being configured to receive the bone screw with screw thread or non-threaded conical nose.

Securing member 120 is inserted through fastener hole 618a, 618b, 618c and 618d make proximal part 612 be attached to tuberosity bone 30.Fastener hole 618a, 618b, 618c and 618d can be spaced apart from each other and along the first longitudinal axes L 1' substantial alignment, this first longitudinal axes L 1' is arranged essentially parallel to the prolonging direction of tuberosity bone 30 when implant 604 is attached to reach tuberosity bone 30 and extends.In one embodiment, proximal part 112 can be longitudinally axis L1' elongation.

Distal portions 614 can become profile and be configured to conform to medial surface or the lateral surface of tibia main body 23, so that implant 604 is attached to tibia main body 23.In addition, the distal portions 614 of implant main body 610 can comprise one or more anchorage point, such as fastener hole.In illustrative embodiment, distal portions 614 comprises fastener hole 622a, 622b, 622c and 622d.Each also size that is configured in fastener hole 622a, 622b, 622c and 622d is set to the securing member 124 receiving and implant 604 can be attached to tibia main body 23, such as bone anchor.

Securing member 124 is inserted through fastener hole 622a, 622b, 622c and 622d make distal portions 614 be attached to tibia main body 23.Fastener hole 622a, 622b, 622c and 622d can be spaced apart from each other and along the second longitudinal axes L 2' substantial alignment.In one embodiment, distal portions 614 can be along second longitudinal axes L 2' extend.First longitudinal axes L 1 angularly can be biased with the second longitudinal axes L 2', so limits angle of eccentricity OA.First longitudinal axes L 1 and the second longitudinal axes L 2' can be biased, and make angle of eccentricity OA between about 170 degree and about 130 degree.In another embodiment, the first longitudinal axes L 1' and the second longitudinal axes L 2' can be biased, and makes angle of eccentricity OA be about 150 degree.In another embodiment, angle of eccentricity OA is about 180 degree (or 0 degree), makes the first longitudinal axes L 1' be parallel with the second longitudinal axes L 2' or is not angularly biased.

The middle implant part 616 of implant main body 610 can be substantially bending.Alternatively, middle implant part 616 can be substantially straight or along the axis elongation angularly biased or parallel with the second longitudinal axes L 2'.Although the attachment location such as fastener hole in the not shown middle implant part 616 of accompanying drawing, it is envisaged that, middle implant part 616 can comprise one or more fastener hole or other suitable attachment features structure any.Middle implant part 616 extends between proximal part 612 and distal portions 614, and by molding, so that relative to distal portions 614, towards front side, tuberosity bone 30 is remained on the amount in reach position or distance by spaced apart being enough to by proximal part 612.

Implant main body 610 also can limit first surface 626 and the second surface 628 back to first surface 626.In one embodiment, when the contiguous tibia 22 of implant 604 is implanted, the tibia main body 23 of tibia 22 faced by first surface 626 is configured to and tuberosity bone 30, and second surface 628 is configured to back to tibia main body 23 and tuberosity bone 30.In another embodiment, when the contiguous tibia 22 of implant 604 is implanted, the tibia main body 23 of tibia 22 faced by second surface 628 is configured to and tuberosity bone 30, and first surface 626 is configured to deviate from tibia main body 23 and tuberosity bone 30.

Implant main body 610 can be limited to the thickness measured between first surface 626 and second surface 628.In one embodiment, along implant main body 610, the thickness of plate can be constant, such as shown in Figure 3.In another embodiment, the thickness of implant main body 610 can be change.Such as, implant main body 610 can limit portions of proximal thickness T1, distal part thickness T2 and mid portion thickness T3.As described above, portions of proximal thickness T1, distal part thickness T2 and mid portion thickness T3 can be all substantially equal.In another embodiment, portions of proximal thickness T1, distal part thickness T2 and mid portion thickness T3 can be substantially unequal.Such as, middle implant part 616 can comprise part 630 that is thinning or constriction, part 630 of this thinning or constriction limits the mid portion thickness T3 of at least one (or alternatively, both) be less than in portions of proximal thickness T1 and distal part thickness T2.Neck down portions 630 and the mid portion thickness T3 reduced can allow implant 604 to be bent or to bend, and compared with when making to have constant thickness with implant main body 610, first surface 626 is closer corresponding with the surface of tibia main body 23 and tuberosity bone 30.In another embodiment, each in portions of proximal thickness T1, distal part thickness T2 and mid portion thickness T3 is greater than, be less than or equal in other parts thickness any one.

In another embodiment, proximal part 612, distal portions 614 or both can comprise part 630 that is thinning or constriction.In proximal part 612, distal portions 614 or mid portion 616, the neck down portions 630 of any one only can comprise a part for corresponding implant part, and corresponding thickness T1, T2 or T3 are changed in this implant part.Neck down portions 630 can comprise at least one transition 632, such as two transition 632, at these transition positions, and the varied in thickness of implant main body 610.As shown in illustrative embodiment, transition 632 can be arc-shaped surface 633, thus causes gradually changing of thickness.In another embodiment, transition 632 can comprise step, thus causes the unexpected change of thickness.In another embodiment, transition 632 can comprise arc-shaped surface 633 and stepped surface, thus causes the part of thickness to gradually change and the part of thickness changes suddenly.In another embodiment, implant main body 610 can comprise different multiple transition 632, such as, a transition with arc-shaped surface 633 632 and another there is the transition 632 of stepped surface.

Implant main body 610 can comprise the first side surface 634 and the second side surface 636 back to the first side surface 634.First side surface 634 and the second side surface 636 can extend in one direction separately and extend between proximal part 612 and distal portions 614 in the other directions between first surface 626 and second surface 628.Implant main body 610 can be limited to the width measured between the first side surface 634 and the second side surface 636.In one embodiment, along implant main body 610, the width of plate can be constant, such as shown in Figure 3.In another embodiment, the width of implant main body 610 can be change.Such as, implant main body 610 can limit portions of proximal width W 1, distal part width W 2 and mid portion width W 3.

As described above, portions of proximal width W 1, distal part width W 2 and mid portion width W 3 can be all substantially equal.In another embodiment, portions of proximal width W 1, distal part width W 2 and mid portion width W 3 can be substantially unequal.Such as, implant main body 610 can comprise the cervical region 638 between proximal part 612 and middle implant part 616, and the width of implant main body 610 is changed along cervical region 638.As shown in illustrative embodiment, the width of implant main body, along cervical region 638 transition, drops to less portions of proximal width W 1 from larger mid portion width W 3.In another embodiment, each in portions of proximal width W 1, distal part width W 2 and mid portion width W 3 is greater than, be less than or equal in other parts width any one.

In one embodiment, implant main body 610 can comprise at least one fan-shaped part 640.Fan-shaped part 640 can comprise peripheral sidewalls 642 and convex surfaces 644.In one embodiment, convex surfaces 644 is stretched out from first surface 626 and can be configured to when contiguous tibia 22 implants implant 604 in the face of the tibia main body 23 of tibia 22 and tuberosity bone 30.In illustrative embodiment, distal portions 614 comprises fan-shaped part 640a, 640b, 640c and 640d.In one embodiment, fan-shaped part 640 can comprise the part of its periphery sidewall 642d of the external boundary not exclusively limiting fan-shaped part 640d.

As shown in illustrative embodiment, implant main body 610 can comprise adjacent fan-shaped part 640, such as fan-shaped part 640b and 640c or fan-shaped part 640c and 640d.By gap 646 separately, this gap 646 part such as 642b and 642c faced by peripheral sidewalls 642 limits adjacent fan-shaped part 640.Gap 646 can extend across the whole width (portions of proximal width W 1, distal part width W 2, mid portion width W 3) of the implant part of the correspondence of the adjacent fan-shaped part 640 of carrying.In the embodiment of alternative, gap 646 only can extend partially through the width of the implant part of the correspondence of the adjacent fan-shaped part 640 of carrying.The width of the implant part of the fan-shaped part 640 that edge carrying is adjacent, the size in gap 646 can be change.Such as, as shown in illustrative embodiment, gap 646 can be wider along end (contiguous the first side wall 634 and the second sidewall 636) place of width in gap 646, and can be narrower around the middle part in gap 646 along width.

Adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c in the face of part can comprise conical section, substantially parallel part or both.In substantially parallel part, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c extends along width substantially parallel to each other, makes the size in gap 646 be constant substantially.In conical section, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c opens away from each other along width.As shown in illustrative embodiment, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c can open linearly away from each other, so limits the first clearance angle 648.First clearance angle 648 can be about 45 degree to about 135 degree, or in another embodiment, the first clearance angle 648 can be about 90 degree.In another embodiment, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c can non-linearly open away from each other.

Except extending along the width of plate, gap 646 also can extend along the thickness of plate, and such as, gap 646 can enter first surface 626 and extend towards second surface 628.In one embodiment, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c opens away from each other along the thickness of implant main body 610.As shown in illustrative embodiment, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c can open linearly away from each other, so limits the second clearance angle 650.Second clearance angle 650 can be about 0 degree to about 60 degree, or in another embodiment, the second clearance angle 650 can be about 30 degree.In another embodiment, adjacent fan-shaped part 640b and the peripheral sidewalls 642b of 640c and 642c non-linearly can open along thickness away from each other.

See Fig. 3 and Figure 11 A-11I, in another embodiment, TTA system 100 can comprise another embodiment of implant 104 (shown in Fig. 3), such as implant 704 (shown in Figure 11 A-11H).Implant 704 can be constructed to bone fixed component 706, such as hone lamella 708.In the embodiment depicted, implant 704 comprises implant main body 710, the middle implant part 716 that this implant main body 710 comprises proximal part 712, relative distal portions 714 and is arranged between proximal part 712 and distal portions 714.The proximal part 712 of implant main body 710 can be configured to be attached to tuberosity bone 30, and this tuberosity bone 30 is being advanced to from primary importance the position that moves forward relative to tibia main body 23 together with kneecap tendon 32 (shown in Fig. 1) on the direction of front side.The distal portions 714 of implant main body 710 can be configured to be attached to tibia main body 23.

Be to be understood that, kneecap tendon 32 is attached to tuberosity bone 30 at anatomy attachment location 43 place, and tuberosity bone 30 can be excised, therefore tuberosity bone 30 separates with tibia main body 23 in the position of attachment location 43 tail side, makes kneecap tendon 32 (comprising attachment location 43) be advanced to from primary importance the position that moves forward together with the tuberosity bone 30 separated.Proximal part 712, distal portions 714 and middle implant part 716 can be totally monomer structure.Alternatively, proximal part 712, distal portions 714 and middle implant part 716 can be the discrete parts being connected to each other to form implant main body 710.

Proximal part 712 can become profile and be configured to conform to medial surface or the lateral surface of tuberosity bone 30, so that implant 704 is attached to tuberosity bone 30.In addition, proximal part 712 comprises one or more attachment location, such as fastener hole.In the embodiment depicted, the proximal part 712 of implant main body 710 comprises four fastener hole 718a, 718b, 718c and 718d.But proximal part 712 can comprise more or less fastener hole.Each fastener hole 718a, 718b, 718c and 718d extend through implant main body 710, and are configured and size is set to receive and implant 704 can be attached to the securing member 120 of tuberosity bone 30, such as bone anchor.Fastener hole 718a, 718b, 718c and 718d can be the screwed hole being configured to receive bone screw.In another embodiment, fastener hole 718a, 718b, 718c and 718d can be the conical screw hole being configured to receive the bone screw with screw thread or non-threaded conical nose.

Securing member 120 is inserted through fastener hole 718a, 718b, 718c and 718d make proximal part 712 be attached to tuberosity bone 30.Fastener hole 718a, 718b, 718c and 718d can be spaced apart from each other and " substantial alignment, this first longitudinal axes L 1 " is arranged essentially parallel to the prolonging direction of tuberosity bone 30 when implant 704 is attached to reach tuberosity bone 30 and extends along the first longitudinal axes L 1.In one embodiment, proximal part 112 can be longitudinally axis L1 " extends.

Distal portions 714 can become profile and be configured to conform to medial surface or the lateral surface of tibia main body 23, so that implant 704 is attached to tibia main body 23.In addition, the distal portions 714 of implant main body 710 can comprise one or more anchorage point, such as fastener hole.In illustrative embodiment, distal portions 714 comprises fastener hole 722a, 722b, 722c and 722d.Each also size that is configured in fastener hole 722a, 722b, 722c and 722d is set to the securing member 124 receiving and implant 704 can be attached to tibia main body 23, such as bone anchor.

Securing member 124 is inserted through fastener hole 722a, 722b, 722c and 722d make distal portions 714 be attached to tibia main body 23.Fastener hole 722a, 722b, 722c and 722d can be spaced apart from each other and along the second longitudinal axes L 2 " substantial alignment.In one embodiment, distal portions 714 can be along the second longitudinal axes L 2 " extends.First longitudinal axes L 1 " can with the second longitudinal axes L 2 " is angularly biased, and so limits angle of eccentricity OA'.First longitudinal axes L 1 " and second longitudinal axes L 2 " can be biased, and makes angle of eccentricity OA' between about 180 degree and about 160 degree.In another embodiment, the first longitudinal axes L 1 " and second longitudinal axes L 2 " can be biased, and makes angle of eccentricity OA' be about 170 degree.In another embodiment, angle of eccentricity OA' is 180 degree (or 0 degree), makes the first longitudinal axes L 1 " with the second longitudinal axes L 2 " be parallel or angularly not be biased.

The middle implant part 716 of implant main body 710 can be substantially bending.Alternatively, middle implant part 716 can be substantially straight or along and the second longitudinal axes L 2 " angularly biased or parallel axis elongation.Although the attachment location such as fastener hole in the not shown middle implant part 716 of accompanying drawing, it is envisaged that, middle implant part 716 can comprise one or more fastener hole or other suitable attachment features structure any.Middle implant part 716 extends between proximal part 712 and distal portions 714, and by molding so that relative to distal portions 714, towards front side, tuberosity bone 30 is remained on the amount in reach position or distance by spaced apart being enough to by proximal part 712.

Implant main body 710 also can limit first surface 726 and the second surface 728 back to first surface 726.In one embodiment, when the contiguous tibia 22 of implant 704 is implanted, the tibia main body 23 of tibia 22 faced by first surface 726 is configured to and tuberosity bone 30, and second surface 728 is configured to deviate from tibia main body 23 and tuberosity bone 30.In another embodiment, when the contiguous tibia 22 of implant 704 is implanted, the tibia main body 23 of tibia 22 faced by second surface 728 is configured to and tuberosity bone 30, and first surface 726 is configured to deviate from tibia main body 23 and tuberosity bone 30.

Implant main body 710 can be limited to the thickness measured between first surface 726 and second surface 728.In one embodiment, along implant main body 710, the thickness of plate can be constant, such as shown in Figure 3.In another embodiment, the thickness of implant main body 710 can be change.Such as, implant main body 710 can limit portions of proximal thickness T1', distal part thickness T2' and mid portion thickness T3'.As described above, portions of proximal thickness T1', distal part thickness T2' and mid portion thickness T3 can be all substantially equal.In another embodiment, portions of proximal thickness T1', distal part thickness T2' and mid portion thickness T3' can be substantially unequal.Such as, middle implant part 716 can comprise part 730 that is thinning or constriction, part 730 of this thinning or constriction limits the mid portion thickness T3' of at least one (or alternatively, both) be less than in portions of proximal thickness T1' and distal part thickness T2'.Neck down portions 730 and the mid portion thickness T3' reduced can allow implant 704 to be bent or to bend, and compared with when making to have constant thickness with implant main body 710, first surface 726 is closer corresponding with the surface of tibia main body 23 and tuberosity bone 30.In another embodiment, each in portions of proximal thickness T1', distal part thickness T2' and mid portion thickness T3' is greater than, be less than or equal in other parts thickness any one.

In another embodiment, proximal part 712, distal portions 714 or both can comprise part 730 that is thinning or constriction.In proximal part 712, distal portions 714 or mid portion 716, the neck down portions 730 of any one only can comprise a part for corresponding implant part, and corresponding thickness T1', T2' or T3' are changed in this implant part.Neck down portions 730 can comprise at least one transition 732, such as two transition 732, at these transition positions, and the varied in thickness of implant main body 710.As shown in illustrative embodiment, transition 732 can be arc-shaped surface 733, thus causes gradually changing of thickness.In another embodiment, transition 732 can comprise step, thus causes the unexpected change of thickness.In another embodiment, transition 732 can comprise arc-shaped surface 733 and stepped surface, thus causes the part of thickness to gradually change and the part of thickness changes suddenly.In another embodiment, implant main body 710 can comprise different multiple transition 732, such as, a transition with arc-shaped surface 733 732 and another there is the transition 732 of stepped surface.

Implant main body 710 can comprise the first side surface 734 and the second side surface 736 back to the first side surface 734.First side surface 734 and the second side surface 736 can extend in a first direction separately and extend between proximal part 712 and distal portions 714 in the other directions between first surface 726 and second surface 728.Implant main body 710 can be limited to the width measured between the first side surface 734 and the second side surface 736.In one embodiment, along implant main body 710, the width of plate can be constant, such as shown in Figure 3.In another embodiment, the width of implant main body 710 can be change.Such as, implant main body 710 can limit portions of proximal width W 1', distal part width W 2' and mid portion width W 3'.

As described above, portions of proximal width W 1', distal part width W 2' and mid portion width W 3' can be all substantially equal.In another embodiment, portions of proximal width W 1, distal part width W 2' and mid portion width W 3' can be substantially unequal.Such as, implant main body 710 can comprise the cervical region 738 between proximal part 712 and middle implant part 716, and the width of implant main body 710 is changed along cervical region 738.As shown in illustrative embodiment, the width of implant main body, along cervical region 738 transition, drops to less portions of proximal width W 1' from larger mid portion width W 3'.In another embodiment, each in portions of proximal width W 1', distal part width W 2' and mid portion width W 3' is greater than, be less than or equal in other parts width any one.

In one embodiment, implant main body 710 can comprise at least one fan-shaped part 740.Fan-shaped part 740 can comprise peripheral sidewalls 742 and convex surfaces 744.In one embodiment, convex surfaces 744 is stretched out from first surface 726 and can be configured to when the contiguous tibia 22 of implant 704 is implanted in the face of the tibia main body 23 of tibia 22 and tuberosity bone 30.In illustrative embodiment, distal portions 714 comprises fan-shaped part 740a, 740b, 740c and 740d.In one embodiment, fan-shaped part 740 can comprise the part of its periphery sidewall 742d of the external boundary not exclusively limiting fan-shaped part 740d.

As shown in illustrative embodiment, implant main body 710 can comprise adjacent fan-shaped part 740, such as fan-shaped part 740b and 740c or fan-shaped part 740c and 740d.By gap 746 separately, this gap 746 part such as 742b and 742c faced by peripheral sidewalls 742 limits adjacent fan-shaped part 740.Gap 746 can extend across the whole width (portions of proximal width W 1', distal part width W 2', mid portion width W 3') of the implant part of the correspondence of the adjacent fan-shaped part 740 of carrying.In the embodiment of alternative, gap 746 only can extend partially through the width of the implant part of the correspondence of the adjacent fan-shaped part 740 of carrying.The width of the implant part of the fan-shaped part 740 that edge carrying is adjacent, the size in gap 746 can be change.Such as, as shown in illustrative embodiment, gap 746 can be wider along end (contiguous the first side wall 734 and the second sidewall 736) place of width in gap 746, and can be narrower around the middle part in gap 746 along width.

Adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c in the face of part can comprise conical section, substantially parallel part or both.In substantially parallel part, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c extends along width substantially parallel to each other, makes the size in gap 746 be constant substantially.In conical section, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c opens away from each other along width.As shown in illustrative embodiment, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c can open linearly away from each other, so limits the first clearance angle 748.First clearance angle 748 can be about 45 degree to about 135 degree, or in another embodiment, the first clearance angle 748 can be about 90 degree.In another embodiment, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c can non-linearly open away from each other.

Except extending along the width of plate, gap 746 also can extend along the thickness of plate, and such as, gap 746 can enter first surface 726 and extend towards second surface 728.In one embodiment, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c opens away from each other along the thickness of implant main body 710.As shown in illustrative embodiment, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c can open linearly away from each other, so limits the second clearance angle 750.Second clearance angle 750 can be about 0 degree to about 45 degree, or in another embodiment, the second clearance angle 750 can be about 10 degree.In another embodiment, adjacent fan-shaped part 740b and the peripheral sidewalls 742b of 740c and 742c non-linearly can open along thickness away from each other.

It should be pointed out that the explanation of embodiment shown in the drawings and discuss only for exemplary purpose, and should not be construed as the restriction disclosure.It will be understood to those of skill in the art that the disclosure contemplates various embodiment.It is to be further understood that except as otherwise noted, otherwise be applicable to all embodiments as herein described with the characteristic sum structure illustrated described by an embodiment.In addition, should be appreciated that the concept described in above use above-described embodiment can be used alone or be combined with above-mentioned other embodiment any.

Claims

1. a TTA system, described TTA system is configured to remain in reach position relative to tibia main body by tuberosity bone, described reach position relative to when described tuberosity bone and described tibia main body integral time primary importance spaced apart towards front side, described TTA system comprises:

Implant, described implant comprises implant main body, and described implant main body limits: proximal part, and described proximal part is configured to support described tuberosity bone in described reach position; Distal portions, described distal portions is configured to be attached to described tibia main body; And middle implant part, described middle implant part extends between described proximal part and described distal portions, described mid portion by molding in case by described proximal part relative to described distal portions towards front side the spaced apart distance being enough to be remained on by described tuberosity bone in described reach position;

Distance piece, described distance piece is configured and size is set in the gap that to be engaged at least in part when described distal portions and described proximal part are attached to described tibia main body and described tuberosity bone respectively and to be arranged between described tuberosity bone and described tibia main body, described distance piece comprises distance piece main body, and described distance piece limits the slit extending through described distance piece main body; With

Distance piece fixed component, described distance piece fixed component comprises: first end part, and described first end part is configured to be attached to described tuberosity bone; The second end part, described the second end part is configured to be attached to described tibia main body; And intermediate fixed portion, described intermediate fixed portion extends between described first end and described the second end, and described intermediate fixed portion is configured and size is set to and is received at least in part in described slit described distance piece fixed component is connected to described distance piece.

2. TTA system according to claim 1, wherein said proximal part limits multiple fastener hole, and described multiple fastener hole is configured to receive securing member described distal portions is attached to described tibia main body separately.

3. TTA system according to claim 1, wherein said distal portions limits multiple fastener hole, and described multiple fastener hole is configured to receive securing member described proximal part is attached to described tuberosity bone separately.

4. TTA system according to claim 1, wherein said first end part limits at least one fastener hole, and at least one fastener hole described is configured to receive securing member described first end part is attached to described tuberosity bone.

5. TTA system according to claim 1, wherein said the second end part limits at least one fastener hole, and at least one fastener hole described is configured to receive securing member described the second end part is attached to described tibia main body.

6. TTA system according to claim 1, wherein said slit is the first slit, and described distance piece limits multiple second slit, described multiple second slit extends to when being arranged in described gap with the described distance piece of box lunch in described distance piece main body and allows osteogenesis.

7. TTA system according to claim 6, its spacers main body is longitudinally extended, and described second slit is angled relative to described longitudinal direction separately.

8. TTA system according to claim 1, wherein said first end part is angularly biased relative to described the second end part.

9. TTA system according to claim 1, wherein said distance piece comprises multiple resilient tines, each in described resilient tines to be configured to when described distance piece is arranged in described gap, towards moving each other, make the shape conforming to described gap at least partially of described distance piece.

10. TTA system according to claim 9, wherein said distance piece comprises distance piece main body, described distance piece limits at least one first fastener hole being configured to receive securing member, at least one fastener hole described extends in described distance piece main body, described intermediate fixed portion limits at least one second fastener hole, and described securing member is configured to be inserted through at least one second fastener hole described and enters at least one fastener hole described so that described distance piece fixed component is connected to described distance piece.

11. TTA systems according to claim 9, wherein said distance piece comprises distance piece main body, described distance piece main body limit upper surface and back to lower surface, and described lower surface limits the shape of basic fovea superior, to be conducive to when described distance piece is arranged in described gap, described resilient tines is towards moving each other.

12. TTA systems according to claim 1, wherein said proximal part extends along first axle, and described distal portions is along the second axis elongation, and described first axle and described second axis are biased relative to each other angledly.

13. TTA systems according to claim 1, wherein said implant main body comprises the first surface be configured in the face of described tibia main body and described tuberosity bone, and with described first surface back to second surface, described implant main body is also limited in described proximal part from the first thickness that described first surface to described second surface is measured, from the second thickness that described first surface to described second surface is measured in described distal portions, and from the 3rd thickness that described first surface to described second surface is measured in described middle implant part, wherein said 3rd thickness is less than at least one in described first thickness and described second thickness.

14. TTA systems according to claim 13, wherein said 3rd thickness is less than described first thickness and described second thickness.

15. TTA systems according to claim 1, wherein said implant main body comprise the first side surface and with described first side surface back to the second side surface, described implant main body is also limited in described proximal part from the first width that described first side surface is measured to described second side surface, from the second width that described first side surface is measured to described second side surface in described distal portions, and from the 3rd width that described first side surface is measured to described second side surface in described middle implant part, wherein said first width is less than at least one in described second width and described 3rd width.

16. TTA systems according to claim 15, wherein said first width is less than described second width and described 3rd width.

17. TTA systems according to claim 1, wherein said implant main body comprise be configured in the face of described tibia main body and described tuberosity bone first surface and with described first surface back to second surface, described implant main body also comprises the fan-shaped part of stretching out from described first surface, and described scallop divides the convex surfaces comprising peripheral sidewalls and be configured in the face of described tibia main body and described tuberosity bone.

18. TTA systems according to claim 17, wherein said scallop is divided into the first fan-shaped part, described implant main body also comprises the second fan-shaped part, and the described peripheral sidewalls of wherein said first fan-shaped part and described second fan-shaped part limits the gap between a part for described peripheral sidewalls facing with each other.

19. TTA systems according to claim 1, also comprise TTA reach assembly, after described TTA reach assembly is configured to carry out osteotomy between described tuberosity bone and described tibia main body, relative to described tibia main body, described tuberosity bone is advanced to described reach position from primary importance, described TTA reach assembly comprises:

Reach main body, described reach main body is configured to be connected to described tibia main body; With

Strut arm, described in strut arm and be connected to described reach main body movingly, described in strut arm and be configured to be connected to described tuberosity bone, strut arm described in making and be configured to move together with described tuberosity bone relative to described tibia main body.

20. TTA systems according to claim 19, wherein described strut arm relative to described reach bulk motion time, the instruction how far that provides described tuberosity bone to move forward from described primary importance towards described reach position of described reach assembly.

21. TTA systems according to claim 20, the assembly that wherein moves forward also comprises the shift scale being connected to described reach main body, and described shift scale is configured to provide described instruction.

22. TTA systems according to claim 19, also comprise angular adjustment component, described angular adjustment component is connected to described reach main body at the attachment location place of described reach main body, wherein said angular adjustment component is configured to the pivot axis relative to being limited by described attachment location, described angular adjustment component comprises contact member, described contact member be configured to be engaged in limited by described osteotomy and be arranged in the gap between described tuberosity bone and described tibia main body.

23. 1 kinds of TTA reach assemblies, after described TTA reach assembly is configured to carry out osteotomy between moved forward tuberosity bone and tibia main body, relative to described tibia main body, described tuberosity bone is advanced to reach position from primary importance, described reach position relative to when described tuberosity bone and described tibia main body integral time described primary importance proximally spaced apart towards front side, the described TTA assembly that moves forward comprises:

Strut arm, the described arm that struts is connected to described reach main body movingly, the described arm that struts is configured to be connected to described tuberosity bone, the wherein said arm that struts is configured to move together with described tuberosity bone relative to described tibia main body, arm is strutted relative to the predetermined distance of described reach bulk motion described in making

Strutting predetermined distance described in arm translation described in wherein making causes described reach assembly to provide described tuberosity bone to be advanced to the instruction of described reach position from described primary importance.

24. TTA reach assemblies according to claim 23, also comprise shift scale, described shift scale is configured to provide described tuberosity bone to be advanced to the described instruction of described reach position from described primary importance, wherein said shift scale is connected to described reach main body, arm is strutted, to strut arm described in box lunch relative to the described translation strutting arm described in measuring during described reach bulk motion described in described shift scale is configured to be arranged essentially parallel to.

25. TTA reach assemblies according to claim 23, also comprise angular adjustment component, described angular adjustment component is connected to described reach main body at the attachment location place of described reach main body, wherein said angular adjustment component is configured to the pivot axis relative to being limited by described attachment location, described angular adjustment component comprises contact member, described contact member be configured to be engaged in limited by described osteotomy and be arranged in the gap between described tuberosity bone and described tibia main body, arm is strutted relative to described osteotomy with predetermined reach angular orientation described in making.

26. TTA reach assemblies according to claim 25, wherein said angular adjustment component is configured to angularly fix relative to described reach main body.

27. TTA reach assemblies according to claim 23, also comprise implant, described implant is configured to be attached to described tuberosity bone and described tibia main body, and strut arm described in described implant is configured to be connected to, strut arm described in making and cause moving together with described tuberosity bone relative to described tibia main body at least partially of described implant relative to the motion of described reach main body.

28. TTA reach assemblies according to claim 27, also comprise brill conductor, described brill conductor is configured to be attached to described implant, and described in strut arm limit bore guide hole, described brill guide hole is configured to receive described brill conductor, make described brill conductor be configured to be connected to when described brill conductor is inserted through described brill guide hole and is attached to described implant described in strut arm and described implant.

29. TTA reach assemblies according to claim 23, wherein said reach main body limits the opening being configured to receive wire rod, make when described wire rod is inserted through described opening and enters described tibia main body, described reach main body can be connected to described tibia main body.

30. TTA reach assemblies according to claim 23, wherein said reach main body is configured to fixture.

31. 1 kinds of TTA methods, after described TTA method is configured to carry out osteotomy between moved forward tuberosity bone and tibia main body, relative to described tibia main body, described tuberosity bone is advanced to reach position from primary importance, described reach position relative to when described tuberosity bone and described tibia main body integral time described primary importance proximally spaced apart towards front side, described method comprises:

By the arm that struts being connected to reach main body movingly, described reach main body is connected to described tuberosity bone, described in strut arm and be configured to relative to described reach bulk motion;

In the gap formed during the contact member being connected to described reach main body is placed in described osteotomy, described gap is arranged between described tuberosity bone and described tibia main body;

Strut arm described in making relative to described reach bulk motion, move between described primary importance and described reach position to make described tuberosity bone.

32. 1 kinds of TTA reach assemblies, after described TTA reach assembly is configured to carry out osteotomy between moved forward tuberosity bone and tibia main body, relative to described tibia main body, described tuberosity bone is advanced to reach position from primary importance, described reach position relative to when described tuberosity bone and described tibia main body integral time described primary importance proximally spaced apart towards front side, the described TTA assembly that moves forward comprises:

Angular adjustment component, being connected to described angular adjustment members pivot described reach main body makes described angular adjustment component be configured to relative to described reach main body around pivot axis, described angular adjustment component comprises contact member, described contact member is configured to be engaged in the gap limited by described osteotomy, wherein said angular adjustment component is configured to fix pivotally relative to described reach main body, make when described contact member is arranged in described osteotomy, reach main body relative to described osteotomy with predetermined reach angular orientation.

33. TTA reach assemblies according to claim 32, also comprise be connected to described reach main body movingly strut arm, the described arm that struts is configured to be connected to described tuberosity bone, the wherein said arm that struts is configured to translation to move together with described tuberosity bone relative to described tibia main body, struts arm relative to the predetermined distance of described reach bulk motion described in making.

34. TTA reach assemblies according to claim 32, wherein said angular adjustment component comprises angle scale, and described angle scale is configured to when described angular adjustment component measures with during described predetermined reach angular orientation relative to described osteotomy.

35. TTA reach assemblies according to claim 32, the main body that wherein moves forward is configured to fixture.

36. TTA reach assemblies according to claim 32, wherein said contact member limits substantially smooth configuration.

37. TTA reach assemblies according to claim 36, wherein said contact member is configured to cutter.